Thinking about surgery and looking for advice

Rich,

There are different types of Laparoscopic Prostatectomy procedures. First my recommendation is Robotic ( most typical today) and absolutely you want a very skilled Surgeon who has done hundreds of Robotic Laparoscopic Prostatectomy’s. Then Robotically the procedures can be broken down further, Davinci Robotic Multiple port entry and the latest DaVinci Single Port entry. Then you want nerve sparing to minimize ED side effects and Retzius sparing to preserve continence by preserving tissue between the bladder and pubic bone and minimizing damage to the tissue and nerves. Then their further techniques in the surgery that also you want to ask about preserving the Puboprostatic ligament which supports the urethra and bladder neck again preserving continence. I have a post about the procedure under Treatment Localized Cancer Type of Prostatectomy by Ned . Now just because a Surgeon is not using a certain technique or the latest DaVinci Robot does not take away from his expertise and your ability to have a very successful prostatectomy with good results and minimal side effects. 

In summary be sure to ask about

Nerve Sparing

Retzius Sparing

Type of Entry (Multiple or Single)

Puboprostatic ligament sparing

Number of his surgeries

Percentage of his patients with continence issues after surgery 

It would certainly seem worth taking all the time you need to research all the options, including AS. Prostate cancer generally moves much more slowly than most other cancers and with a T1 Gleason 6 diagnosis you should have plenty of time.

There are of course pros and cons to all the options including AS. With AS the biggest con is probably the danger that the original diagnosis proves to be over-optimistic (as several members of this site can testify). There is also the anxiety which many would find very difficult. On the plus side, however, as Adrian has said, it is by no means certain that you would need to have treatment eventually - a lot of men on AS never need to have radical treatment. Another advantage of waiting is that treatments techniques are still improving, both on the surgery and radiation sides. In addition, diagnostics and scans are also improving - I still entertain the hope that we will arrive at a situation where tests can distinguish with much better accuracy precisely which cancers will or will not need to be treated.

My best wishes to you whatever you do decide to do.

Kevin

Edited by member 29 Oct 2024 at 10:31  | Reason: Not specified

Hi,

I have just been diagnosed (last week) with a T1 / Gleeson 6 score.  My PSA is currently 4.8 and apparently only 1 of my 18 biopsy samples scored a hit so initial feedback is that it is contained and potentially slow growing.  My PSA has been rising steadily over the past 18 months (it has been steady at 2.6/2.7 for the past few years) and only just started to get up during the night for a pee (although this is highly variable and only since taking Tamsulosin).

In the overall scheme of things this is the lowest of the low as far as scores go but still needs to be dealt with.  I am 60 years old and have been tracking my PSA for 9 years now since my older brother was diagnosed with incurable prostate cancer aged 49 and passed away aged 52.  Strangely I am relieved it has been found as I have known this will catch up with me eventually.

I am usually very active, not over weight, non smoker and a keen marathon and ultra runner and looking at the options that will address the cancer but also looking at recovery times as keen to get back on the trails as soon as possible.

My initial reaction is to go for surgery, particularly how quickly it developed for my brother.  The ED does not bother me although slightly concerned about the incontinence and how long this might last for. 

I live in Scotland and very interested in the lead times with the NHS up here.  Any views ?  I do have insurance and also considering that if it will make a difference.  Anyone with experience of the Scottish NHS - pros and cons ?

I would love to get your views on the downsides of the surgery, how long the incontinence might last, anything outside of ED and incontinence they don't tell you about upfront and anything else I should know ?  Any other runners out there who have been through this and what has been your experience ?

My first follow up call since diagnosis with the nurse will be later this week and then a follow up with the urologist shortly after that.  This all feels a bit surreal right now as feel fine otherwise (other than just recovering from ankle surgery but that is a different story).

Thanks in advance.